Provider First Line Business Practice Location Address:
701 UNIVERSITY BLVD. EAST
Provider Second Line Business Practice Location Address:
SUITE 807
Provider Business Practice Location Address City Name:
TUSCALOOSA
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-344-6961
Provider Business Practice Location Address Fax Number:
205-344-6497
Provider Enumeration Date:
07/28/2005